Article Figures & Data
Figures
- FIGURE 1.
Anterior planar images demonstrating global accumulation of 123I-MIBG in myocardium at 15 min (A) and 4 h (B) after injection. Standard global regions of interest are red; modified regions of interest are blue. Lung and liver regions are purple. Images highlight need for greater discriminatory power using SPECT. Nonetheless, H:M ratio is on order of 2, and washout is marked at 4 h.
- FIGURE 2.
Polar map demonstrating regional cardiac 123I-MIBG distribution at 15 min (left) and 4 h (right) after intravenous administration. Arrows highlight areas of denervation that correspond to similar regions of hypoperfusion on end-diastolic polar map in 99mTc-MIBI study (Fig. 3) but show thickening and motion (Fig. 4).
- FIGURE 3.
Polar map demonstrating regional myocardial perfusion (%) at end-diastole (A) and end-systole (B). Perfusion deficits are seen in inferior and inferolateral walls. Arrows highlight areas of decreased perfusion in distal left anterior descending region that correspond to similar regions of 123I-MIBG denervation (Fig. 3).
- FIGURE 4.
Polar map demonstrating regional myocardial thickening (A) and wall motion (B). Arrows highlight areas of decreased perfusion and denervation in distal left anterior descending region that show both thickening and motion. Septal paradoxic motion can be appreciated, and inferior and inferolateral hypokinesia is also apparent.
Tables
NYHA classification ACC/AHA classification Description Class Class Description — A High risk of developing heart failure but no functional or structural heart deficits No limitation and no symptoms from ordinary activity I B Structural heart deficit but no symptoms Mild limitation with activity and comfortable at rest or with mild exertion II C Heart failure symptoms due to underlying structural heart deficit with medical management Significant limitation with any activity and comfortable only at rest III C Heart failure symptoms due to underlying structural heart deficit with medical management Discomfort with any physical activity and symptoms occurring at rest IV D Advanced disease requiring hospitalization, transplant, or palliative care — Arrows indicate potential directions of stage progression. Horizontal alignment indicates corresponding stages between the 2 classifications.
Investigator Parameter Healthy cohort Heart failure cohort P Matsuo et al. (25) LVEF (%) 73 ± 7 31 ± 1 <0.05 Delayed H:M 2.6 ± 0.3 1.8 ± 0.9 <0.05 Washout (%) 28 ± 3 38 ± 3 <0.05 Zhao et al. (26) LVEF (%) 71.0 ± 11.2 22.0 ± 8.4 — Delayed H:M 2.66 ± 0.21 1.73 ± 0.39 — Washout (%) 11.88 ± 7.23 31.58 ± 11.18 — Bengel et al. (27) Delayed H:M 2.8 ± 0.55 2.36 ± 0.66 0.04 Washout (%) 0.2 ± 10.2 11.6 ± 7.9 0.002 Data are mean ± SD.
- TABLE 3
H:M and Washout Rates for Optimistic and Pessimistic Approaches to Region-of-Interest Placement
Parameter Whole heart/upper mediastinum Whole heart/lower mediastinum Regional heart/upper mediastinum Regional heart/lower mediastinum Early H:M 2.15 1.66 2.65 2.05 Delayed H:M 2.21 1.65 2.55 1.90 Heart Washout 34.2% 34.2% 38.3% 38.3% Tabulated data show some variability; however, best and worst cases are consistent with low-risk H:M and abnormal washout.
Parameter Uptake index Regional washout rate (%) Washout index (uptake index) Early anterior 1.67 40.9% 0.93 Delayed anterior 1.79 Early lateral 0.85 33.9% 0.83 Delayed lateral 1.02 Early inferior 0.58 56.9% 1.29 Delayed inferior 0.45 Early septal 1.47 34.1% 0.84 Delayed septal 1.76 Early apical 1.02 46.2% 1.02 Delayed apical 1.00 Parameter Healthy cohort Heart failure cohort LVEF (%) 54.6 ± 17.7 16.8 ± 9.6 Delayed MUP 2.12 ± 0.36 1.23 ± 0.52 Washout (%) 1.04 ± 16.8 38.18 ± 18.52 MUP = uptake index.
Data are mean ± SD.
